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Pennsylvania rates for HCPCS 49452

Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $2,691.53 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $630.96 / $1,905.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,570.40 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $741.31 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $645.65 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $302.00 / $1,445.44
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,479.11
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $933.25 / $1,318.26
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,570.40 / $5,370.32
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $151.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $2,398.83 / $7,244.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $676.08 / $2,041.74
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,737.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,412.54 / $2,089.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $416.87 / $912.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $416.87 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,819.70 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $524.81 / $1,288.25